Pituitary Tumours and Hyperprolactinomia

Question 1

What are non-functional pituitary adenomas?

Answer 1

• Do not release hormones
• Test visual fields
• Brain MRI with contrast

Question 2

What are functional pituitary adenomas?

Answer 2

1. Acromegaly (GH secreting)
2. Prolactinoma (prolactin secreting)
3. Cushing’s disease (ACTH secreting)

Question 3

What can pituitary adenomas cause?

Answer 3

1. Pituitary adenomas of either type can compress other parts of pituitary gland
   So CAUSE Hypopituitarism
2. Can compress optic chiasm causing bitemporal hemianopia

Question 4

What are two types of causes of hyperprolactinomaia?

Answer 4

1. physiological

2. pathological

Question 5

What are physiological causes of hyperprolactinomia?

Answer 5

1. pregnancy

2. breastfeeding

Question 6

What are pathological causes of hyperprolcatinomia?

Answer 6

1. Prolactinoma
2. Other pituitary adenoma (stalk compression)
3. Primary hypothyroidism

Question 7

What is the male presentation of hyperprolocatinomia?

Answer 7

1. Loss of libido
2. erectile dysfunction
3. infertility
4. (galactorrhoea) uncommon

Question 8

What is the female presentation of hyperprolocatinomia?

Answer 8

1. Galactorrhoea
2. secondary amenorrhoea/oligomenorrhoea
3. loss of libido
4. infertility

Question 9

What is the mass effect of tumour in hyperprolactiomia?

Answer 9

headaches/visual field defect

Question 10

What does high prolactin suppress?

Answer 10

GnRH pulsatility

Question 11

What investgations are done for hyperorlacitnoma?

Answer 11

1. Pregnancy test (exclude physiological hyperprolactinaemia)
2. TFTs
3. Basal serum prolactin – if in 6,000+ mU/L almost certainly prolactinoma
4. MRI preferred imaging

Question 12

What is 1st line management of hyperprolactinomia?

Answer 12

1. Dopamine receptor (D2) agonist

2. e.g. bromocriptine, cabergoline which reduce prolactin secretion and tumour size

Question 13

What is 2nd line management of hyperprolactinoma?

Answer 13

surgery